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About Us
About Us
Testimonials
FAQ’s
Blog
Home Care
Home Care
Medicaid Planning
Private Pay
CDPAP
NHTD
NHTD
TBI
Work For Rockaway
Work For Rockaway
Employee Links
Keeper
Rockaway Rewards
Employee Referral Program
Forms
FSA Card(Melody)
Get Verified
Contact
516-239-8693
Direct Deposit Authorization Agreement
Name
(Required)
First
Last
Phone
(Required)
Email
(Required)
Direct Deposit Info
(Required)
Bank Name
Routing Number
Account Number
Amount/Percent
Add
Remove
Consent
(Required)
I agree to the privacy policy.
I hereby authorize the Company to directly deposit any salary or wages due to me, less any mandatory or authorized withholdings or deductions in the bank account(s) listed above in the percentages specified. (If two or more accounts are designated, deposits are to be made in whole percentages of pay to total 100%.)
The Company will credit my account(s) the amount of my payroll check on payday. The Company will provide me with a check stub on payday listing my deductions and pay to be available on the Empeon Employee Self Portal. Deposits are normally available the morning of pay date however each bank posts funds to accounts at different times daily, and the Company has no control over my bank’s posting.
I authorize my financial institution to accept direct deposits to my account upon receipt and without advice to me. It is my responsibility to verify deposits on a per pay date basis before writing checks against these funds. I understand that the Company is not responsible for bank errors or bank fees. Banking services are provided in accordance with the limitations and restrictions of the Automated Clearing House Association.
This authorization is to remain in force until the Company has received written authorization from me of its termination or change. I understand that if my account has closed, my financial institution cannot accept a deposit on my behalf. If this occurs, my employer will not be able to process any further direct deposits without further written authorization from me. IN ORDER TO TERMINATE OR REVOKE THIS AUTHORIZATION, I MUST NOTIFY MY EMPLOYER IN WRITING AT LEAST TWO WEEKS PRIOR TO THE TERMINATION.
Changes to direct deposit may take 2-4 weeks to process.
Signature
(Required)
Name
(Required)
First
Last
Date Signed
(Required)
MM slash DD slash YYYY
Comments
This field is for validation purposes and should be left unchanged.
How can we help you?
Please select one option
Signup For Home Care
Signup For CDPAP
Start Working With Rockaway
Name
First
Last
Email
Phone
Select Location(s)
(Required)
Brooklyn
Bronx
Manhattan
Queens
Staten Island
Rockland
Suffolk County
Nassau County
Westchester
Are you?
(Required)
A licensed Home Health Aide (HHA)
A licensed Personal Care Aid (PCA)
Looking for training
Are you the patient?
(Required)
Yes
No
Does the patient have Medicaid?
(Required)
Yes
No
I am not sure
One MUST have MEDICAID to enroll in the CDPAP program. Medicare is NOT enough
Would you like help applying or determining eligibility?
(Required)
Yes
No
Are you looking to pay privately or with long term care insurance?
(Required)
Yes
No
Again, one is NOT eligible to enroll in the CDPAP program WITHOUT MEDICAID
Consent
Yes, Rockaway can contact me via txt, email, or calls to provide more information
CAPTCHA
Comments
This field is for validation purposes and should be left unchanged.
How can we help you?
Please select one option
Signup For Home Care
Signup For CDPAP
Start Working With Rockaway
Name
First
Last
Email
Phone
Select Location(s)
(Required)
Brooklyn
Bronx
Manhattan
Queens
Staten Island
Rockland
Suffolk County
Nassau County
Westchester
Are you?
(Required)
A licensed Home Health Aide (HHA)
A licensed Personal Care Aid (PCA)
Looking for training
Are you the patient?
(Required)
Yes
No
Does the patient have Medicaid?
(Required)
Yes
No
I am not sure
One MUST have MEDICAID to enroll in the CDPAP program. Medicare is NOT enough
Would you like help applying or determining eligibility?
(Required)
Yes
No
Are you looking to pay privately or with long term care insurance?
(Required)
Yes
No
Again, one is NOT eligible to enroll in the CDPAP program WITHOUT MEDICAID
Consent
Yes, Rockaway can contact me via txt, email, or calls to provide more information
CAPTCHA
Name
This field is for validation purposes and should be left unchanged.